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U.S. Department of Health and Human Services

Public Health Service

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Healthy People 2000 is a statement of national opportunities. Although the Federal Government
facilitated its development, it is not intended as a statement of Federal standards or requirements. It is
the product of a national effort, involving 22 expert working groups, a consortium that has grown to
include almost 300 national organizations and all the State health departments, and the Institute of
Medicine of the National Academy of Sciences, which helped the U.S. Public Health Service to manage
the consortium, convene regional and national hearings, and receive testimony from more than 750
individuals and organizations. After extensive public review and comment, involving more than 10,000
people, the objectives were revised and refined to produce this report.

PUB RA 395 A3 H475 1990 V, 2

Foreword

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Americans today are taking a more active interest in their health than ever before. They
are coming to realize the influence that they, themselves, can have on their own health
destinies and on the overall health status of the Nation.
It wasn't always thus. Until fairly recently, we Americans gave little thought to health as
a positive concept. The past 15 years or so, however, have witnessed important changes
in our thinking about the protection and enhancement of personal health. Three of those
changes are of great importance for the well-being of our people as we move into the
final decade of this century.
First, personal responsibility, which is to say responsible and enlightened behavior by
each and every individual, truly is the key to good health. Evidence of this still-evolving
perspective abounds in our concern about the dangers of smoking and the abuse of al-
cohol and drugs; in the emphasis that we are placing on physical and emotional fitness; in
our growing interest in good nutritional practices; and in our concern about the quality of
our environment. We have become, in a word, increasingly health-conscious, increasing-
ly appreciative of the extent to which our physical and emotional well-being is dependent
upon measures that only we, ourselves, can affect.
We can control our health destinies in significant ways, then, but if we are to realize,
fully, the benefits of assuming that control, and this is the second of the three points I
would make, we must find the means of extending the benefits of good health to the most
vulnerable among us.
The correlation between poor health and socio-economic status has been well docu-
mented, but that does not make it right or inevitable. Good health should not be seen, or,
for that matter, be permitted to exist in fact, as a benefit for only those who can afford it;
it should be available and accessible to every citizen.
Medical care, alone, will not eliminate the devastating impact of chronic disease on the
disadvantaged, nor will it reduce, as much as we would like, the rate of infant mortality
or the burden of homicide and violence or any of the other "health” problems that are
bome by the poor in our society. If we are to extend the benefits of good health to all our
people, it is crucial that we build in our most vulnerable populations what I have called a
"culture of character,” which is to say a culture, or a way of thinking and being, that ac-
tively promote responsible behavior and the adoption of lifestyles that are maximally con-
ducive to good health. This is "prevention” in the broadest sense. It is also an absolute
necessity, both because we are a humane and caring society and because, if we are to
remain a vital society, we cannot afford to waste human resources. Good health must be
an equal opportunity, available to all Americans.
Finally, health promotion and disease prevention comprise perhaps our best opportunity
to reduce the ever-increasing portion of our resources that we spend to treat preventable
illness and functional impairment. Smoking, for example, is the single most preventable
cause of death and illness in this country. Smoking-related illnesses cost our health care
system more than $65 billion annually.
AIDS is an almost entirely preventable disease. The cost of caring for a person with
AIDS for his or her lifetime is, today, about $75,000. The annual cost of treating all diag-
nosed AIDS patients, about $4.3 billion this year, could climb as high as $13 billion by
1992, the Public Health Service estimates.

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The yearly cost of treating alcohol and drug abuse is at least $16 billion. The total economic impact of alcohol and drug abuse, including not only treatment but premature death, accidents, crime, and lost productivity, is more than $110 billion annually. We would be terribly remiss if we did not seize the opportunity presented by health promotion and disease prevention to dramatically cut health-care costs, to prevent the premature onset of disease and disability, and to help all Americans achieve healthier, more productive lives. Healthy People 2000: National Health Promotion and Disease Prevention Objectives addresses these three points. It lays out a series of national opportunities. To support the development of these opportunities, a national consortium composed of nearly 300 national membership organizations and all of the State health departments joined the Department's Public Health Service to solicit and analyze comments and suggestions from people across the Nation. The Federal Departments of Agriculture, Education, Labor, and Transportation and the Environmental Protection Agency participated generously in the development of the national objectives. In regional and national hearings, the Public Health Service and its partner in this venture, the Institute of Medicine of the National Academy of Sciences, learned what people from many sectors of society consider to be the priorities for prevention in the coming decades. This input has shaped the content of Healthy People 2000 as it has evolved from its first drafts through extensive public review and comment to the final publication. Participants included health professionals and others in health-related industries. The Department has had the honor of serving as a convener and facilitator in developing these goals, but they truly belong to the Nation. I commend this document for your consideration, to use as appropriate in your community. All those who participated in its development over the past three years can take pride in its clarity of vision. All of us can feel humility in the face of its monumental challenges, but we also can share a new sense of resolve to move forward to achieve a nation of healthy people.

Louis W. Sullivan, M.D.
Secretary

September 1990

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